ABSTRACT
<p><b>OBJECTIVE</b>To study the accuracy of position estimation of right-sided double-lumen endobronchial tubes (DLTs) without carinal hook in elderly patients according to the changes of inspiratory peak airway pressure (Ppeak), lung compliance (Cdyn), pressure-volume loop (P-V loop), and flow-volume loop (F-V loop).</p><p><b>METHODS</b>Ninety-six elderly patients undergoing thoracic surgery were intubated with right-sided Mallinckrodt DLTs, the depth of which was determined based on the regressive equation. After 15 min of two lung ventilation (TLV), the Ppeak showed a more than 50% increase from the baseline in 22 patients when switching to one lung ventilation (OLV) with Cdyn less than 50% of the baseline and Ppeak in excess of 22 cmH(2)O. In these 22 cases, the position of the DLT was determined by fiberoptic bronchoscope (FOB) and adjusted to the precise position at 15 min of OLV.</p><p><b>RESULTS</b>DLTs were inserted into the right middle bronchi in 19 cases and the right lower lobe bronchi in 3 cases. At 124-/+39 s after OLV, the SpO(2) began to decrease, and the Ppeak of OLV increased by 91.0% and Cdyn decreased by 62.7%. The slope of P-V curve was reduced and the P-V loop extended, with reduced increment of the expiratory limb and the area of the F-V loop, so that the tips of the DLT were withdrawn by 0.5 to 1.9 cm. The Ppeak of OLV increased only by 43.4% when DLT was in correct position, and was Cdyn decreased by 33.6% ( P<0.01).</p><p><b>CONCLUSION</b>When changes of Ppeak and Cdyn in excess of above guidelines occurs after switching from TLV to OLV in the elderly patients, FOB should be applied to determine the tip position of DLT before SpO(2) reduction takes place.</p>
Subject(s)
Aged , Female , Humans , Male , Bronchoscopy , Methods , Fiber Optic Technology , Intubation, Intratracheal , Methods , Respiratory Mechanics , Spirometry , Thoracic Surgical ProceduresABSTRACT
<p><b>OBJECTIVE</b>To observe the incidence of double-lumen endobronchial tubes (DLT) malposition caused by body position change or surgical manipulation and its impact on the efficacy of lung separation and ventilation.</p><p><b>METHODS</b>Totally 688 patients undergoing thoracic surgery were enrolled in this study. The patients were intubated with Mallinckrodt DLT following intravenous anesthesia induction. The DLT position was corrected with fiberoptic bronchoscope (FOB), and successful lung separation and satisfactory ventilation were ensured during one-lung ventilation in the supine position. Bronchoscopy was performed immediately and the DLT position was corrected 15 minutes after dependent lung ventilation in the lateral position or in case of ineffective lung separation or SpO(2) declination to below 90%.</p><p><b>RESULTS</b>DLT malposition occurred after lateralization in 112 (16.3%) patients, of whom 12.8% developed hypoxemia and 3.3% encountered air leak. The incidence of left-sided DLT malposition after lateralization was higher than that of right-sided DLT malposition (19.7% vs 12.2%, P<0.01). DLT malposition occurring in 112 patients after lateralization reoccurred in 16 (14.3%) patients during surgery, and the malposition incidence was significantly higher than that of malposition occurring only during surgery (1.2%, P<0.01).</p><p><b>CONCLUSION</b>Malposition of Mallinckrodt double-lumen tubes for lung separation during thoracic anesthesia occurs in 16.3% patients when shifting to lateral position, may reoccur in 14.3% of the patients despite previous FOB positioning.</p>